|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 03780D6
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 03774D6
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047N0DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047Y3FZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 05730D1
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 05730DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047D3DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 037L4EZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 05733D1
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 037Q4FZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$19,726.00
|
|
|
Service Code
|
ICD 02714T6
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$19,726.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,726.00
|
| Rate for Payer: Blue Shield of California EPN |
$16,911.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,519.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047Y0FZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047Y0GZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047Y3D6
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047Y3DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 057N0DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 057N3DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 037U3DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 04700D6
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047P3FZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047P3EZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047B3DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047C0D6
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047C0DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$19,726.00
|
|
|
Service Code
|
ICD 02723T6
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$19,726.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,726.00
|
| Rate for Payer: Blue Shield of California EPN |
$16,911.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,519.00
|
|
